Development and validation of an individual sustainable diet index in the NutriNet-Santé study cohort

In the current context of unsustainable food systems, we aimed to develop and validate an index, the sustainable diet index (SDI), assessing the sustainability of dietary patterns, including multidimensional individual indicators of sustainability. Based on the FAO's definition of sustainable diets, the SDI includes seven indicators categorised into four standardised sub-indexes, respectively, environmental, nutritional, economic and sociocultural. The index (range: 4-20) was obtained by summing the sub-indexes. We computed the SDI for 29 388 participants in the NutriNet-Santé cohort study, estimated its validity and identified potential socio-demographic or lifestyle differences across the SDI quintile. In our sample, the SDI (mean=12·10/20; 95 % CI 12·07, 12·13) was highly correlated to all the sub-indexes that exerted substantial influence on the participants' ranking. The environmental and economical sub-indexes were the most and less correlated with the SDI (Pearson R 2 0·66 and 0·52, respectively). Dietary patterns of participants with a high SDI (considered as more sustainable) were concordant with the already published sustainable diets. Participants with high SDI scores were more often women (24 %), post-secondary graduates (22 %) and vegetarians or vegans (7 %), without obesity (16 %). Finally, the SDI could be a useful tool to easily assess the sustainability-related changes in dietary patterns, estimate the association with long-term health outcomes and help guide future public health policies.